Enroll here for the APA After School Program for the 2020-2021 school year.
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Students entered below will be added to your family's account
Are you currently enrolled in any other program at APA? If so, which ones?
What school do you attend?
What time does carpool run at your school (from 0:00-0:00)?
Which days of the week would you like to attend (M, T, W, TH, F).
Has your child ever been referred to a resource teacher or specialist?
If yes, please provide date and reason for referral.
Has the applicant ever been administered psychological, behavioral, or academic testing to determine if he or she is gifted, has a learning disability, ADD, ADHD, or for any other reason?
If yes, please provide any additional information we may need to know to best care for your child.
What specific reasons helped you determine that the APA After School Program is the right fit for your family?
Please tell us how you heard about the APA After School Program. If you were referred by a friend, put that person's name here.
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*